Sonography Findings Predict Testicular Viability in Pediatric Patients With Testicular Torsion

Abstract

Background: Testicular torsion poses a pediatric surgical emergency that necessitates rapid diagnosis and surgery to prevent testicular loss. We sought to determine whether any particular findings on Doppler ultrasound (US) were predictive of testicular viability in pediatric patients with testicular torsion.Materials and methods: We identified males between ages one and 18 years who experienced testicular torsion over a six-year period (January 1, 2015-December 31, 2020). All patients were evaluated at our institution's emergency department by a pediatric urologist and underwent a Doppler scrotal US.Results: Of the 140 patients with testicular torsion, 56 (40%) had a non-viable testis and underwent an orchiectomy, while 84 (60%) had a viable testis and orchiopexy. Testicular heterogeneity (47 [84%] vs 48 [57%], p = 0.001), epididymis heterogeneity (23 [41%] vs 21 [25%], p = 0.063), and scrotal wall thickening (25 [45%] vs 5 [6%], p < 0.001) were significantly associated with a non-viable testis. Epididymis heterogeneity (adj. odds ratio [OR] = 0.33 [0.13, 0.79], p = 0.013) and scrotal wall thickening (adj. OR = 0.08 [0.03, 0.24], p < 0.001) exhibited significantly lower odds for viability. Testicular heterogeneity and scrotal wall thickening were more likely to develop with a longer duration of symptoms (both p < 0.001). Conclusion:Our study determined that certain Doppler scrotal US findings, specifically, testicular and epididymal heterogeneity as well as a thickened scrotal wall, are associated with testicular demise in patients with testicular torsion. As testicular heterogeneity and scrotal wall thickening are more likely to arise with a longer symptom duration, an urgent diagnosis and prompt surgical intervention are imperative to avert testicular loss.

Testicular Torsion with Intact Blood Flow: A Point of Care Ultrasound Case-Series

“…Typically, a twist of 450 degrees or more causes complete occlusion of blood flow to the testis 5 . Prolonged ischemia will cause marbling of the testis and correlates with poor prognosis 10 .…”

Visualizing the early-stage testicular torsion by dual-modal photoacoustic and ultrasound imaging

“…USI is an efficient, practical, radiation-free and noninvasive method to diagnose TT. Despite the high diagnostic accuracy of USI for complete TT, it may lead to false-negative diagnoses in cases of incomplete TT [13] , [29] , [30] , [31] , [32] . As a novel imaging technique, PAI can exploit an sO 2 map of tissue to offer more valuable information [33] .…”

Ultrasound findings to predict failure of conservative treatment in the appendix testis torsion

“…Mushtaq et al reported a misdiagnosis rate of 12.5% in the case of TT, 17% for TAT, and 44% for epididymitis [22]. The literature remarks on the importance of US in enhancing the diagnostic power of clinical examination alone [23][24][25][26][27][28][29]. TAT's clinical management is not homogenous across the world.…”